Wednesday, April 1, 2015

What Ebola? Where?

 
 

As noted yesterday, Ebola is not, in fact, gone from any of the three most heavily impacted countries in West Africa.
In fact, the weekly tallies right now are running at a fairly steady percentage of what they were during the apparent peak weeks last fall.
And without laboring yesterday's point, based purely on admittedly bogus numbers of dubious reliability, for any given point in this outbreak, including now.

In the past, outbreaks have burned out; usually by killing 90% of everyone in some remote village, and then going away because the other 10% survived/were immune.

We don't know how the Index Patient in this outbreak contracted it. Just like we don't know where any other Index Patient in any prior outbreak contracted it.

But this time, it hasn't gone away. Because this time, there's a near limitless pool of new victims, because it isn't confined to some remote little village. It's gotten loose across entire countries, and in the large cities thereof.

And it simply hasn't disappeared in any of them. It waxes and wanes, but it's still infecting people, and still killing them in droves. Despite everything we know (and don't know), and despite everything we've done and not done, it just keeps on keeping on.

It keeps infecting the careless, the stupid, the ignorant, and even those taking special precautions and wearing frickin' hazmat gear.

We did not duck this bullet, it just went over our heads last time.
There is absolutely NO reason to assume this will continue to be the case. In fact, rather the opposite: every day it doesn't spread just makes the day it does more inevitable. Like against terrorists, we have to get lucky every time, this virus just has to get lucky once. The calculus on that argues for preparation for what is clearly inevitable.

So how's that going over here?
No ban on flights here from there.

But why do that? No one has gotten here since they started the screenings.

Yeah. And signs prohibiting it are what keeps elephants out of the trees at the local park.

Which argues for several things:
* the screening measures, shoddy as they are, have been good enough to stop obviously infected people from travelling, in most cases (they wouldn't have stopped Duncan)
* it's harder to spread early on, and thus early infectees who are pre-symptomatic are the only ones who can make it past the screening
* we're dealing with a target population for whom taking an airplane flight is only slightly more likely than flying to space.

Unfortunately, that means that:
* those who do travel will have the means to go anywhere
* they won't raise suspicions until they're far from the minimal screenings that exist
* they'll then become symptomatic amidst their home populations, long after they're not under any sort of organized and mandated surveillance, and thus all reporting is completely on their honor and best behavior.

And as witnessed with Dr. Special Case, Dr. Special News Reporter, and Nurse Mimi Crybabypants, people, even trained medical professionals, are self-serving lying little shits who will endanger the public recklessly and repeatedly, left to their own devices, where Ebola and the horrors of quarantines (which latter have been instituted and accepted by all civilized people since medieval times) are concerned.

And that's just assuming the disease stays in West Africa, behind the current zone of interest.
If it gets out of that zone, like the Germans going around the end of the Maginot Line, there isn't anydamnthing to stop it or even slow it down.

And what about here?
We still have a treatment capacity of 11 beds, nationwide. And several of those are permanently reserved for military research casualties, so it's really only 7-8 beds.
I.e., the same number of Ebola cases in any of the three originally affected African countries by Week Two.

Then, it's back to local hospitals.
Which is to say, the Worst Of All Possible Worlds.

Dallas gave you a glimpse of what to expect.

As I've related, I've been flitting hither and yon locally in my professional capacity.
I'm here to tell you, having now seen multiple local hospitals, it's far worse than I could have imagined.

Most hospitals have no supply of protective gear for even a single outbreak case.
Many have no negative airflow room in which to place the victim(s).
None have more than a very few of them.
All of them require moving an infected patient through the entire ER, from lobby to treatment area, completely exposing not only visitors, but their entire staffs, to potentially infectious material.
None of the ERs I've worked at has any personal protective equipment rapidly available.
None of them has adequate PPE available for more than a few staff members.
None of them has conducted anything but cursory training in dealing with potential infectees; most have conducted none at all, and a few don't even address the possibility of it ever becoming necessary.
None of them has any capability to sort infected people before they enter the hospital, nor do most have any plans to do so.
The ones that do have plans are mainly limited to vague incantations about setting up some ad hoc magical whatsis. None have actual sorting facilities, decontamination abilities, nor have held any training or exercises to practice such implementation.
None of them has any capability to treat so much as one potential case, and still safely stay open to other patients, yet that is precisely what they have done and will continue to do, until it becomes apparent that they've already contaminated their entire staff, the entire ER, and recklessly and deliberately exposed dozens to hundreds of unprotected people to the disease.

Go back and read that last sentence again.

Bear in mind we're talking about busy ERs in a diverse, multi-lingual major metropolitan area, wherein reside approximately 10% of the entire US population, countless international tourist destinations, multiple international airports, three major seaports, and an international border within 1-2 hours' ground travel distance. Not the 2 bed ER in Podunk, Inner Wyoming.

Now let's talk about your ER, especially if you're within a tank of gas of those five major destination airports for flights from West Africa.

Then let's talk about your ER if you don't even have that going for you.

And now I'm not even on the home team in those ERs?
Potential Ebola Case walks in, I'm out. Period. Done. B'bye.

And the difference for me is, at least I'll know something there, because they'll come in with suspicious symptoms.
What are you going to do when someone coughs in the market, or is sitting next to you in the theatre or the bus with a fever? Wait until blood is shooting out of their eyes?

Best wishes with that plan.

I repeat, Dallas was a warning shot.

IIRC, Duncan was sick in hospital for a week or so before he died. I don't know how many nurses cared for him there; at 2/day it could have been as many as 14, plus ancillary staff, or as few as two. And with their inadequate protective measures (the same ones I've seen ready or not at most local hospitals) that means he successfully infected between 14% and 100% of his direct caregivers.

All of whom KNEW he had Ebola before they walked into his room.

His one case closed that entire ER for the duration-plus, and the ICU, and for all intents and purposes, a 400- or 500-something bed major acute hospital became a ghost town overnight. It may yet stave off financial ruin and bankruptcy.

Based on the early reports of the first nurse's lawsuit, I wouldn't hold my breath there, and despite the blow to the community, they probably don't deserve to stay open.

Then there was the disruption and expense to the city and county, from a grand total of three actual cases: Duncan himself, and the two nurses. (And both of them were evac'ed to two of those eleven beds mentioned earlier pretty rapidly.)

So the moral of the story is, the first eight or so people infected here have a shot.
Patient Number Nine and following will stand about the same chance as victims in Africa.
Which is somewhere between a 10 to a 40% chance of survival.
And, evidently from recent news, with a lifetime's major permanent disabilities and sequellae, including lifelong vision deficits up to and including permanent blindness in many cases.

So yeah, Ebola has plateaued at a fraction of its peak, but refuses to burn out.
Which is merely that same exponential growth curve, on "Pause".

And given the current mutually-agreed-upon news blackout, your first clue it's rolling again will be when they announce on the news that someone is at County General, and came in shooting blood out both ends after they collapsed at the mall.

And then it's last September all over again.

Oh, BTW, for reference, at one of those ERs, in one week's time I've taken care of ten patients who came in with such routine symptoms as coughing blood, vomiting blood, and/or bleeding out their back end. We won't even talk about how many had fever, headache, and body or joint aches. So yeah, we'll get right on catching that Ebola patient the first time they come through the ER, because it's so easy to spot.

Just like they did in Dallas.

Sleep tight.

23 comments:

Anonymous said...

The lack of anthropological - for lack of a better word - understanding of how this virus or family of viri has become endemic in sub-saharan africa is the biggest impediment to dealing with it. This type of virus is likely just as common in the s.american and s.e. asian jungles yet doesn't flair up there or in near by metropoli. Why?

Aesop said...

Actually, it's probably not just as common.

But the hosts and a suitable breeding environment are there if it ever gets to them.

And if the disease ever makes the jump to equatorial S. America, India, or the rest of Asia, we can then look forward to ever-increasing incidents of the disease breaking out in multiple places at the same time.

And we can't even manage it now, in the continent with the most hindrance to internal and external travel. If it gets to a tropical megatropolis or two, it's going worldwide in short order.

RushBaby said...

"equatorial"

Hmmm... You might be on to something there, Aesop.

After I hit Raconteur Report, my very next click is always here:

http://earth.nullschool.net/#current/wind/isobaric/1000hPa/overlay=temp/orthographic=23.86,3.16,352

I mouse all around that map to check out global weather conditions. It has various built-in overlays that you can apply to it. I follow wind and temperature.

Interestly, Africa's land mass is the very largest one at the equator.

After studying the conditions over time, it is no wonder that so much of Africa is a desert. Offshore breezes are consistently blocked from coming inland.

Also interesting, for the months that I have been following this map, the climate that most resembles Africa is...America.

mike18xx said...

The rains are pouring down again over the Guinea forest region: http://climate.cod.edu/flanis/satellite/polar/index.php?type=polar-wv-48

Numbers should commence a jumping.

Aesop said...

Well, the cases should start jumping.

What the number'll do is anyone's guess.

Anonymous said...

http://medicalxpress.com/news/2015-04-baby-dies-ebola-sleone-area.html

second round ...!


SF

RushBaby said...

There were 8 new health worker infections in the last week of March: 7 in Guinea, and 1 in Sierra Leone. This brings the total number of health worker infections in W,Africa to 861, with 495 deaths.

I wonder if the media will trumpet the eventual magic 500 number with as much fanfare as they announced troop deaths in Iraq under Bush.

geoffb said...

From a March 3rd piece. At that time the "official" toll was ~9800 deaths.

"[T]he secretary general of the Red Cross warned that the true number of victims could be substantially greater than official estimates.

“Even though statistics show that over 9,000 people died of Ebola, our volunteers on the ground were called on to bury 14,000, which means that many more died from Ebola,” Mohammed El-hadj Assy told a conference on the Ebola crisis in Brussels on Tuesday. "


At the link where I found the above mentioned there was also the claim made as factual that for some unnamed period of 10 days in late Feb. early March 2015 Liberia had not had a single confirmed new case. This as I and others have said is belied by the "official" government numbers themselves which chronicle the week by week upward march of both cases and deaths in all three countries.

The only "official" slowdown for Liberia is 2/22 to 3/1 where they report an increase of only 11 cases for the week. The next week jumps to 96 and then the following week is 183 cases. At no time is there a zero lull for 10 days either in cases or deaths.

Anonymous said...

Anyone got the final disposition of the health worker cases in the UK and the US?

I haven't seen anything.

nick

geoffb said...

The one patient at NIH Bethesda was released as cured on the evening of April 9th.

Anonymous said...

Getting Stranger by the day ..used to be 3 months now 6 !!

Ebola Survivors Urged To Practice Safe Sex After Virus Detected In Semen of survivor Six Months Later

http://www.ibtimes.com/ebola-survivors-urged-practice-safe-sex-after-virus-detected-semen-six-months-later-1882805

''Traces of Ebola have been found in the semen of a man six months after his recovery, the World Health Organization said Wednesday, urging survivors to practice safe sex "until further notice".

The man had been declared free of the deadly virus in Liberia last September, WHO spokesman Tarik Jasarevic told AFP.

"He has provided a semen sample which has tested... positive for Ebola, 175 days after his negative blood test," he said in an email.

The UN health agency had previously said the virus had been detected in semen around three months after a patient had been declared Ebola free.''

Aesop said...

Which could also explain one reason why the disease pops back up.

No word from our own Ebola survivors about this, presumably.

But it'll be great when "cured" health care workers start infecting spouses and significant others who have no foreign travel, hundreds of miles from ports of entry, and months after any sort of long-term surveillance has ended.

Anonymous said...

Mystery disease kills 18 in Nigeria. This is too fast for Ebola!

http://www.bbc.com/news/world-africa-32365830

geoffb said...

Just think of the possibilities that are inherent for the EU.

Anonymous said...

Question: Aesop, what do you think about the FDA investigation of hand sanitizers used in hospitals?

See the article at:

http://elkodaily.com/twinfalls/ap/washington/fda-seeks-more-data-on-safety-of-hospital-hand-cleaners/article_aba4fa5a-9017-55ca-9801-859d501601c3.html

Aesop said...

I think it points out that they weren't paying any bloody attention to them (and their efficacy) in the first place, and are now trying to play catch-up.
Pretty much like every government bureaucracy anywhere, ever.

Nothing like a study of barn door locks once the horses are out to generate more requests for increased agency funding.

RushBaby said...

Oh looky here (via Drudge):

Abridged for brevity:

Dr. Ian Crozier, a 43-year-old American physician diagnosed with Ebola in September while working with WHO in Sierra Leone.

He was treated at Emory University in Atlanta and released in October. Two months later, he developed an inflammation and very high blood pressure in one eye.

He returned to Emory, where anophthalmologist drained some of the fluid and it tested positive for Ebola.

http://tinyurl.com/maw68am

Whoop, there it iiiis!

Reckon the implication is that survivors MAY be carriers for the rest of their lives.

geoffb said...

Ebola, the disease which has completely vanished,

Poof it's gone.

Though its ghost continues to rack up new cases & deaths even in the very belated "official" reports.

It's definitely a tricky devil of a disease. Bodies are not all it infects.

geoffb said...

Everything is working just fine.

"He had traveled from Liberia through Morocco, landing at New York's John F. Kennedy International Airport on May 17. He did not have a fever when he left Liberia and did not report symptoms of Lassa fever, which include diarrhea, vomiting or bleeding, during his flight, the CDC said.

The man, whose temperature was taken when he arrived in the USA, also did not have a fever at the airport, the CDC said. Officials began screening passengers for Ebola-like symptoms at five U.S. airports last fall.

The man went to a hospital in New Jersey on May 18 with symptoms of a sore throat, fever and tiredness. According to the hospital, he was asked about his travel history and he did not mention going to to West Africa. Hospital staff sent the man home the same day.

The man returned to the hospital Thursday, May 21 when his symptoms got worse, the CDC said. Hospital staff transferred the man to a treatment center prepared to treat viral hemorrhagic fevers. The man tested positive for Lassa fever early Monday morning, but did not test positive for Ebola. The patient was in "appropriate isolation" at the hospital when he died Monday evening, the CDC said.
"

Tukangtahu Upload said...

Ebola Myths & Facts For Dummies-For Dummies (2015).pdf - 1.3 MB
http://www.anafile.com/c38rq9xoy6xf.html

geoffb said...

Oopsie.

Aesop said...

Nice find, geoffb.

Proving once again, all Liberian claims are subject to ever-upward revision.
Particularly given that this kid lived in the capitol, not some monkey-eating jungle backwater. This is the same strain, same outbreak, and they still haven't stomped it out. If that's even possible, given the viral load spread throughout the cities.

Anonymous said...

..........Nice..^_^v............